The trouble with weight (stigma): From weight-centric to health-at-every-size physiotherapy
Notice bibliographique
Résumé
Participants ranged from those explicitly espousing anti-fatness and pro-thinness beliefs as a basis for physiotherapy practice to those who have taken up sophisticated ways to disrupt it. The latter developed a critical consciousness about weight, weight stigma, and ‘diet culture’ mainly on their own, outside of the profession. At the core of this development was learning to trouble the common story in their societies and in physiotherapy: that weight is a simple reflection of lifestyle and willpower. Instead, they reframed the trouble as that of navigating weight stigma, as it manifests internally, interpersonally, and structurally. Those with a critical consciousness of weight stigma used the narrative features of luck and ‘a journey’ to describe their transformation into their present self, aided by mentors from other backgrounds, their own experiences of recovery from disordered eating and exercise behaviors, and/or engaging with HAES® and trauma-informed care sources. They repeatedly returned to the idea of patients’ experiences and feelings, describing patients as whole, complex characters facing high stakes situations, where their needs are often unrecognized and unmet. Compare HAES® and other physiotherapists’ understandings of, and clinical practices relating to, weight stigma, including how it manifests and practices which disrupt it. Physiotherapists demonstrating a critical consciousness of weight stigma and practice had to learn to work against the grain of what they were formerly taught, both in physiotherapy education and more broadly. Future research should address how weight stigmatization is reproduced and/or disrupted in physiotherapy education, and ethnographic studies of physiotherapy sites can inform dialogue about weight-inclusive practices within the profession. We completed a narrative inquiry study informed by a public advisory board with lived experience of weight stigma in health care. We generated data using a story completion method followed by 70–90 minute semi-structured interviews with a purposive sample of 11 physiotherapists from Australia, Canada, and the USA. Sampling emphasized a mix of physiotherapists practicing Health At Every Size® and those without anti-weight stigma training. Multiple interview techniques emphasized the telling and interpreting of stories. The primary analysis approach was socionarratology (Frank, 2010). If physiotherapy seeks to be an inclusive, health-enhancing profession, learning to disrupt stigmatization on the basis of bodily fatness should not depend on luck. A concerted effort is needed to disrupt anti-fatness and pro-thinness as it manifests in education and practice.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,016 | 0,026 |
| Communication savante | 0,007 | 0,008 |
| Science ouverte | 0,001 | 0,017 |
| Intégrité de la recherche | 0,003 | 0,009 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».